Grau Gerard, Brunet-Mas Eduard, Llovet Laura Patricia, Pedregal Patricia, Villoria Albert, Melcarne Luigi, Puy Anna, Garcia-Sague Belen, Frisancho Luis Enrique, Ramírez-Lázaro María José, Lario Sergio, Calvet Xavier
Servicio Aparato Digestivo, Centro Médico Teknon, 08028 Barcelona, Spain.
Servei d'Aparell Digestiu, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Departament de Medicina, Universitat Autònoma de Barcelona, 08207 Sabadell, Spain.
J Clin Med. 2023 Oct 17;12(20):6571. doi: 10.3390/jcm12206571.
Thiopurines are an effective treatment for the maintenance of remission in inflammatory bowel disease (IBD). They can present adverse effects (AEs), with myelotoxicity being the most relevant. This study aims to determine the incidence of AEs related to the starting of thiopurines in our centre.
Retrospective study. The AEs in patients that were started on thiopurines between January 2016 and June 2020 were registered, with a two-year follow-up. The mean and standard deviation were used to describe the quantitative variables, and percentages and confidence intervals were used for the qualitative variables. The statistical significance was set at a -value < 0.05.
98 patients were included, with 64 AEs detected in 48 patients (49%). Most of the AEs appeared in the first 6 months. The most relevant were: 21 neutropenia (21.4%), 19 hypertransaminasemia (19.4%), 13 digestive intolerances (13.2%), 6 acute pancreatitis (6.12%), 3 phototoxicity (3%), and 2 unknown origin fevers (2%). In 29 patients (29.4%) the treatment had to be suspended due to AEs. In 11 cases (11.2%), azathioprine (AZA) was switched to 6-mercaptopurine (6 MP) as 5 showed tolerance and 6 patients needed suspension due to AEs. Eight patients required hospital admission, but none of them needed intensive care unit admission. There were no fatal adverse effects.
Thiopurines are a safe drug with few AEs, especially after the first months of treatment. These results suggest that periodic analytic follow-up may not be necessary after the initial period of treatment.
硫嘌呤类药物是维持炎症性肠病（IBD）缓解的有效治疗方法。它们可能会出现不良反应（AE），其中骨髓毒性最为相关。本研究旨在确定在我们中心开始使用硫嘌呤类药物后相关不良反应的发生率。
回顾性研究。记录2016年1月至2020年6月开始使用硫嘌呤类药物的患者的不良反应，并进行为期两年的随访。使用均值和标准差描述定量变量，使用百分比和置信区间描述定性变量。统计学显著性设定为P值<0.05。
纳入98例患者，48例患者（49%）检测到64例不良反应。大多数不良反应出现在前6个月。最相关的不良反应为：21例中性粒细胞减少（21.4%）、19例转氨酶升高（19.4%）、13例消化不耐受（13.2%）、6例急性胰腺炎（6.12%）、3例光毒性（3%）和2例不明原因发热（2%）。29例患者（29.4%）因不良反应不得不暂停治疗。在11例患者（11.2%）中，硫唑嘌呤（AZA）换成了6-巯基嘌呤（6MP），因为5例显示耐受，6例因不良反应需要停药。8例患者需要住院，但均无需入住重症监护病房。没有致命的不良反应。
硫嘌呤类药物是一种安全的药物，不良反应较少，尤其是在治疗的最初几个月后。这些结果表明，在治疗初期过后可能无需进行定期分析随访。
